Long-term Care

Pain management is often inadequate for elderly patients hospitalized for surgery

Nearly 9 million elderly patients are hospitalized for surgery each year, and they often do not receive adequate management of their pain. Assessment and reassessment of acute pain are not done in a manner consistent with current practice recommendations, according to a study supported by the Agency for Healthcare Research and Quality (HS10482). The study found that only 37 percent of 709 elderly patients undergoing surgery (98 percent for repair of hip fracture) at 12 hospitals had the recommended pain assessment every 4 hours during the first 24 hours following admission. This is the time period when pain following hip fracture is likely to be high.

Only 5.5 percent of patients received every 4-hour pain assessment for the entire 72 hours studied, with 26 percent of patients receiving every 8-hour pain assessment. The use of patient-controlled analgesia (PCA) did not increase every 4-hour assessment during the first 24 hours the PCA was running. In the first 24 hours following admission and for the entire 72-hour period, only 22 percent and 15 percent, respectively, of patients administered non-PCA analgesics had their pain reassessed within 60 minutes.

Meperidine was the most frequently administered opioid (31 percent); PCA was used infrequently (27 percent); and over 50 percent of the patients received at least one intramuscular injection, a route not recommended for older adults. Around-the-clock administration of analgesics was used infrequently (22.3 percent), and patients with dementia received significantly less parenteral morphine equivalent of opioids than those without dementia.

The study was led by Marita G. Titler, Ph.D., R.N., F.A.A.N., and Keela Herr, Ph.D., R.N., of the University of Iowa. Drs. Titler and Herr and their colleagues based their findings on an analysis of medical records of the 709 patients at the 12 hospitals studied and nurse questionnaire responses.

See "Evidence-based assessment of acute pain in older adults: Current nursing practices and perceived barriers," by Drs. Herr and Titler, Margo L. Schilling, M.D., and others, in the September 2004 Clinical Journal of Pain 20(5), pp. 331-340.

For more information on this topic, please see the earlier article by these authors: "Acute pain treatment for older adults hospitalized with hip fracture: Current nursing practices and perceived barriers, in the November 2003 Applied Nursing Research 16(4), pp. 211-227.

Editor's Note: Another AHRQ-supported study on a related topic examined ways to improve pain management in nursing homes. For more details see Jones, K.R., Fink, R., Vojir, C., and others (2004). "Translation research in long-term care: Improving pain management in nursing homes." (AHRQ grant HS11093). Worldviews on Evidence-Based Nursing Third Quarter Supplement, pp. S13-S20.

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